CAPE COD TRIAL

Hydrocortisone in Severe Community Acquired Pneumonia

Beneficial/useless?The ride for steroid seems like a roller coaster in severe CAP.

Severe CAP has a significant mortality upto 10% of those admitted to ICU. Use of steroid has been contentious in CAP with differing recommendations.

This was a phase 3,multicenter,double-blind,randomized controlled trial done across 31 French centres. Data was collected from 0ctober 2015-March 2020.

800 patients underwent randomization and data from 795 patients were analyzed.

The patients assigned for admission to ICU for severe CAP, were to receive either hydrocortisone(200mg daily for either 4 or 8 days as determined by clinical improvement,followed by tapering for a total of 8 or 14 days) or to receive placebo.

Outcome:

Primary Outcome:

1. DEATH BY DAY 28:HYDROCORTISONE(6.2%) vs PLACEBO(11.9%).

Secondary Outcome:

1. HOSPITAL ACQUIRED INFECTION BY DAY28:HYDROCORTISONE(9.8%) vs PLACEBO(11%). insignificant difference.
2. GI BLEEDING BY DAY 28:HYDROCORTISONE(2.2%) vs PLACEBO(3.3%). insignificant difference.
3. MEDIAN DAILY DOSE OF INSULIN BY DAY7:HYDROCORT(35.5) vs PLACEBO(20 IU/DAY).MORE IN TREATMENT GROUP.
4. DEATH BY DAY 90:HYDROCORT(9.3%) vs PLACEBO(14.7%).
5. INCIDENCE OF ENDOTRACHEAL INTUBATION BY DAY 28:HYDROCORT(18%) vs PLACEBO(29.5%).
6. INCIDENCE OF ENDOTRACHEAL INTUBATION IN THOSE NOT RECEIVING AT BASELINE, BY DAY 28:HYDROCORT(19.5%) vs PLACEBO(27.7%).
7. INCIDENCE OF VASOPRESSOR INITIATION IN THOSE NOT RECEIVING AT BASELINE, BY DAY 28:HYDROCORT(15.3%) vs PLACEBO(25%).

So, in conclusion hydrocortisone reduced 28 day mortality in those admitted to ICU with severe CAP.

Steroid is beneficial,but only in the sickest of the pneumonia patients(with the most systemic inflammation).

So, steroid is worth considering in severe CAP, because we are exploiting the anti-inflammatory and immunomodulatory effects of steroids in decreasing the mortality. WHICH SEEMS QUITE SENSIBLE AND SCIENTIFICALLY APPEALING. ISN’T IT?????

Want to know more about this study? Click Here!

By Dr. Kishalaya Chakraborty for CCEM Journals